Healthcare Provider Details

I. General information

NPI: 1952045254
Provider Name (Legal Business Name): LAITH ENANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 CAMPUS POINT DR # MC7774
LA JOLLA CA
92037-1300
US

IV. Provider business mailing address

9300 CAMPUS POINT DR # MC7774
LA JOLLA CA
92037-1300
US

V. Phone/Fax

Practice location:
  • Phone: 858-249-1702
  • Fax: 619-543-3812
Mailing address:
  • Phone: 858-249-1702
  • Fax: 619-543-3812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA208253
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberVB244
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA208253
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberV8244
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: